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12 <br /> North Carolina Department of Transportation r- �'" W <br /> Division of Highways [1.) <br /> Petition for Road Addition 13 <br /> .v, f)t:Ut, Qi 1ie311 1.r0i.�3(iOCI <br /> ,� !l�yjhw��:��, lth Divo <br /> ROADWAY INFORMATION: (Please Print/Type) Division Dtsttitil 1 - (atdham <br /> County: OR.--thli&E Road Name: 5�72.R`��O Gai y <br /> (Please list additional street names and lengths on the back of this form.) <br /> Subdivision Name: (tIE I? S&" V Length (miles): <br /> Number of occupied homes having street frontage: Located (miles): <br /> miles N ❑S ❑ E ❑ W ❑ of the intersection of Route and Route <br /> (Check one) (SR,NC,US) (SR,NC,US) <br /> We, the undersigned, bein property owners nd/or developers of QE-/'/2 i/O 6.04y in <br /> ORj )-E County, do hereby request the Division of Highways to add the above described road. <br /> CONTACT PERSON: Name and Address of First Petitioner.(Please Print/Type) <br /> Name: \TE `V'Yi/T :-79-g2-- t Phone Number: C7fQ-- 933-7 57 <br /> Street Address: lO 5 80LIEV - ' aii9y <br /> M , i L1 ffw 12 77 <br /> PROPERTY OWNERS <br /> r e. Mailing Address Telephone <br /> /e y <br /> Lbri IN, • • diA: C) (gq Se-reto,t-c) L q/9 96 g-61/2-1 <br /> c 4 ,i n v 19 S(t) i <br /> f & e <br /> H ivQvO 9t9 a42 z <br /> Form SR-1 (3/2006; Rev 1/2010) <br />